Should laparoscopic appendectomy be avoided for complicated appendicitis in children?
Should laparoscopic appendectomy be avoided for complicated appendicitis in children?
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DOI：
10.1016/s0022-3468(97)90462-0
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发表时间：
1997-11-01
影响因子：
2.4
通讯作者：
Lally, KP
中科院分区：
文献类型：
--
作者：
Horwitz, JR;Custer, MD;Lally, KP
背景/目的：腹腔镜阑尾切除术正成为治疗急性阑尾炎的首选技术。然而，最近关于成人的文献表明，腹腔镜阑尾切除术可能会增加并发症（坏疽或穿孔）病例的术后感染并发症的风险。本研究的目的是比较开放式阑尾切除术与腹腔镜阑尾切除术治疗儿童复杂性阑尾炎的结果。方法：回顾性分析1994年1月至1996年11月间两所医院收治的顽固性阑尾炎患儿的资料。结果：本组56例患儿中，腹腔镜阑尾切除术27例，开放式阑尾切除术22例，由腹腔镜转为开放式手术7例。手术时间和住院时间在腹腔镜组和开放组之间无显著差异。术后并发症24例（42.8%）。腹腔镜阑尾切除术后并发症发生率高于开放式阑尾切除术（56% vs 18%, P = 0.002）。术后腹腔内脓肿（IAA） 14例（25%）。开放性阑尾切除术后2例患儿发生IAA，腹腔镜阑尾切除术后11例患儿发生IAA （9% vs 41%, P = 0.01）。结论：研究结果表明，由于术后腹内脓肿的风险增加，患有复杂性阑尾炎的儿童应避免腹腔镜阑尾切除术。作者提出了一项前瞻性随机试验来验证这一发现。版权所有(C) 1997由W.B. Saunders公司。
Background/Purpose: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, recent literature on adults suggests that laparoscopic appendectomy may increase the risk for postoperative infectious complications in complicated (gangrenous or perforated) cases. This study was undertaken to compare the results of open versus laparoscopic appendectomy for complicated appendicitis in children.Methods: A retrospective review from two institutions was performed for all children treated operatively for complicated appendicitis from January 1994 through November 1996.Results: Fifty-six cases were identified, Twenty-seven children underwent laparoscopic appendectomy, whereas 22 underwent open appendectomy, Seven children underwent conversion from laparoscopic to open surgery. Operating times and length of hospital stay did not differ signficantly between the laparoscopic and open groups. Postoperative complications developed in 24 children (42.8%). Complications were more frequent after laparoscopic appendectomy compared with open appendectomy (56% v 18%, P = .002). A postoperative intraabdominal absess (IAA) developed in 14 children (25%). An IAA occurred in two children after open appendectomy compared with 11 children after laparoscopic appendectomy (9% v 41%, P = .01).Conclusion: The findings suggest that laparoscopic appendectomy should be avoided in children who have complicated appendicitis because of the increased risk for postoperative intraabdominal abscesses, The authors propose a prospective, randomized trial to verify this finding. Copyright (C) 1997 by W.B. Saunders Company.